Healthcare Provider Details

I. General information

NPI: 1750645172
Provider Name (Legal Business Name): NICHOLAS REID M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2012
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9250 COLUMBIA AVE STE 2E
MUNSTER IN
46321-3530
US

IV. Provider business mailing address

9250 COLUMBIA AVE STE 2E
MUNSTER IN
46321-3530
US

V. Phone/Fax

Practice location:
  • Phone: 219-595-0043
  • Fax: 312-754-9402
Mailing address:
  • Phone: 219-595-0043
  • Fax: 312-754-9402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number125061459
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: